Mutual Antagonism of T Cells Causing Psoriasis and Atopic Eczema

• Published in: The New England journal of medicine Vol. 365; no. 3; pp. 231 - 238
• Main Authors: Eyerich, Kilian, Eyerich, Stefanie, Onken, Anna T, Weidinger, Stephan, Franke, Andre, Nasorri, Francesca, Pennino, Davide, Grosber, Martine, Pfab, Florian, Schmidt-Weber, Carsten B, Mempel, Martin, Hein, Ruediger, Ring, Johannes, Cavani, Andrea
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 21-07-2011
• Subjects: Adolescent; Adult; Allergens; Allergic diseases; Allergies; Antigens; Arthritis; Atopy; Biological and medical sciences; Biopsy; Cell division; Cytokines; Dermatitis; Dermatitis, Atopic - complications; Dermatitis, Atopic - drug therapy; Dermatitis, Atopic - immunology; Dermatitis, Atopic - microbiology; Dermatology; Disease; Eczema; Female; Flow cytometry; General aspects; Helper cells; Humans; Immunopathology; Interleukin-4 - therapeutic use; Lymphocytes; Lymphocytes T; Male; Medical sciences; Middle Aged; Patients; Psoriasis; Psoriasis - complications; Psoriasis - drug therapy; Psoriasis - immunology; Psoriasis. Parapsoriasis. Lichen; Skin allergic diseases. Stinging insect allergies; Staphylococcus aureus - isolation & purification; T cell receptors; T-Lymphocytes, Helper-Inducer - immunology; Th1 Cells - immunology; Th17 Cells - immunology; Th2 Cells - immunology; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Tumor necrosis factor-TNF; Medicine; Allergy; Immunopathology; Skin disease; Antagonism; Psoriasis; Eczema; T-Lymphocyte; Atopy
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa1104200

The skin infiltrates of atopic eczema consist predominantly of type 2 helper T cells, whereas those of psoriasis are mainly types 1 and 17. The two diseases are elicited by different types of antigens and are largely mutually exclusive, since one type of infiltrate antagonizes the other.
Psoriasis and atopic eczema are prevalent, influence health-related quality of life, are associated with concomitant illness, and pose an economic burden. Whether these diseases are epithelial or immunologic disorders is debated. Both involve complex interactions of hereditary factors and environmental influences. Besides altering the skin barrier, these conditions lead to a systemic T-cell–driven immune response with primary involvement of not only the skin but also other sites such as joints (in psoriatic arthritis) or airways (in asthma and rhinitis). Whereas atopic eczema arises from a systemic Th2-cell–dominated immune shift characterized by frequent elevations of total and allergen-specific IgE levels,
1
psoriasis . . .